ACE基因多态性对右美托咪定抑制高血压患者气管拔管反应的影响

摘要

Objective To evaluate the effect of angiotension-converting enzyme (ACE) gene poly-morphism on dexmedetomidine-induced inhibition of responses to extubation in the patients with hyperten-sion. Methods A total of 180 patients with primary hypertension, aged 50-63 yr, weighing 54-69 kg, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, scheduled for elective abdominal surgery under general anesthesia, in whom ACE genotypes were detected using polymerase chain reaction-restriction fragment length polymorphism, were divided into 6 groups (n = 30 each) according to whether dexmedeto-midine was applied: DD genotype group (DD group), ID genotype group (ID group), Ⅱ genotype group (Ⅱ group), dexmedetomidine +DD genotype group (DEX+DD group), dexmedetomidine +ID genotype group (DEX+ID group) and dexmedetomidine+Ⅱ genotype group ( DEX+Ⅱ group). Dexmedetomidine 0. 5 μg·kg-1 ·h-1 was intravenously infused starting from 30 min before the end of surgery until the end of surgery in DEX+DD, DEX+ID and DEX+Ⅱ groups. Immediately before infusing dexmedetomidine (T1 ), at 30 min of dexmedetomidine infusion (T2 ), immediately after extubation (T3 ) and at 1. 5, 5 and 15 min after extubation (T4-6 ), systolic blood pressure, diastolic blood pressure, heart rate and ECG were recor-ded, and rate-pressure product was calculated. The development of myocardial ischemia and responses to extubation was recorded within 15 min after extubation. Results Compared with the baseline at T1 , each parameter of hemodynamics was significantly increased at T3-6 in DD, ID and Ⅱ groups (P<0. 05), and no significant change was found in each parameter of hemodynamics at T2-6 in Dex+DD, Dex+ID and Dex+Ⅱ groups (P> 0. 05). Each parameter of hemodynamics was significantly lower at T3-6 , and the inci-dence of myocardial ischemia and responses to extubation was decreased in group Dex+DD than in group DD and in group Dex+ID than in group ID (P<0. 05). Compared with group Ⅱ, each parameter of he-modynamics at T3-6 and incidence of responses to extubation were significantly decreased in group Dex+Ⅱ, and each parameter of hemodynamics was significantly increased at T3-6 , and the incidence of myocardial ischemia and responses to extubation was increased in DD and ID groups (P<0. 05). There was no signif-icant difference in each parameter of hemodynamics or incidence of myocardial ischemia and responses to extubation among group Dex+DD, group Dex+ID and group Dex+I (P>0. 05). Conclusion ACE gene polymorphism does not affect dexmedetomidine-induced inhibition of responses to extubation in the patients with hypertension.%目的 评价血管紧张素转换酶(ACE)基因多态性对右美托咪定抑制高血压患者气管拔管反应的影响.方法 选择全麻下行腹部手术的原发性高血压患者180例,年龄50～63岁,体重54～69 kg,ASA分级Ⅱ或Ⅲ级,术前采用RFLP-PCR法测定ACE基因型,并根据是否应用右美托咪定分为6组(n=30):DD基因型组(DD组)、ID基因型组(ID组)、Ⅱ基因型组(II组)、右美托咪定+DD基因型组(DEX+DD组)、右美托咪定+ID基因型组(DEX+ID组)和右美托咪定+Ⅱ基因型组(DEX+II组).DEX+DD组、DEX+ID组和DEX+Ⅱ组于手术结束前30 min静脉输注右美托咪定0.5μg·kg-1·h-1,直至术毕.于给予右美托咪定前即刻(T1)、给予右美托咪定30 min(T2)、气管拔管后即刻(T3)、气管拔管后1.5、5和15 min(T4-6)时,记录SP、DP、HR和ECG,并计算心率收缩压乘积;记录气管拔管后15 min内心肌缺血和气管拔管反应的发生情况.结果 与T1时比较,DD组、ID组和Ⅱ组T3-6时血流动力学各指标升高(P<0.05),Dex+DD组、Dex+ID组和Dex+Ⅱ组T2-6时血流动力学各指标差异无统计学意义(P>0.05);与DD组比较,Dex+DD组T3-6时血流动力学各指标降低,心肌缺血和气管拔管反应发生率降低(P<0.05);与ID组比较,Dex+ID组T3-6时血流动力学各指标降低,心肌缺血和气管拔管反应发生率降低(P<0.05);与II组比较,Dex+Ⅱ组T3-6时血流动力学各指标和气管拔管反应发生率降低,DD组和ID组T3-6时血流动力学各指标升高,心肌缺血和气管拔管反应发生率升高(P<0.05);Dex+DD组、Dex+ID组和Dex+I组间各时点血流动力学各指标、心肌缺血和气管拔管反应发生率比较差异无统计学意义(P>0.05).结论 ACE基因多态性不会影响右美托咪定抑制高血压患者气管拔管反应.